Impact and determinants of nurse turnover: a pan-Canadian study

o’brien-pallas l., murphy g.t., shamian j., li x. & hayes l.j. (2010) Journal of Nursing Management 18, 1073–1086
Impact and determinants of nurse turnover: a pan-Canadian study Aim As part of a large study of nursing turnover in Canadian hospitals, the present study focuses on the impact and key determinants of nurse turnover and implications for management strategies in nursing units. Background Nursing turnover is an issue of ever-increasing priority as work-related stress and job dissatisfaction are influencing nurses’ intention to leave their positions. Methods Data sources included the nurse survey, unit managers, medical records and human resources databases. A broad sample of hospitals was represented with nine different types of nursing units included. Results Nurses turnover is a major problem in Canadian hospitals with a mean turnover rate of 19.9%. Higher levels of role ambiguity and role conflict were associated with higher turnover rates. Increased role conflict and higher turnover rates were associated with deteriorated mental health. Higher turnover rates were associated with lower job satisfaction. Higher turnover rate and higher level of role ambiguity were associated with an increased likelihood of medical error. Conclusion Managing turnover within nursing units is critical to high-quality patient care. A supportive practice setting in which role responsibilities are understood by all members of the caregiver team would promote nurse retention. Implications for nursing management Stable nurse staffing and adequate managerial support are essential to promote job satisfaction and high-quality patient care.     

The impact of nurse empowerment on job satisfaction

Title. The impact of nurse empowerment on job satisfaction. Aim. This paper is a report of a study conducted to test Kanter’s organizational empowerment theoretical model specifying the relationships among demographics, structural empowerment, and job satisfaction. Background. Empowerment has become an increasingly important factor in determining nurses’ job satisfaction in current restructured work environments in China. Methods. A correlational, cross‐sectional design was used to test Kanter’s organizational empowerment model with a sample of 650 full‐time nurses employed in six Chinese hospitals in 2007, with a response rate of 92% (n = 598). The instruments used were the Demographic Data Questionnaire, Conditions of Work Effectiveness Questionnaire‐II, and Job Satisfaction Scale. Results. The three lowest scoring items for Conditions of Work Effectiveness Questionnaire‐II were resources, opportunity and informal power. The job satisfaction items revealing most dissatisfaction were workload and compensation, professional promotion, amount of work responsibility, work environments, and organizational policies. A statistically significant positive correlation was found between empowerment and job satisfaction (r = 0·547, P < 0·01). The demographic factors influencing empowerment were work objectives and age. The influencing factors for job satisfaction were work objectives and education level. Conclusion. The results provide support for Kanter’s organizational empowerment theory in the Chinese nurse population. Nurses who view their work environments as empowering are more likely to provide high quality care. Enhancing empowerment in a supportive environment would allow nurses to experience satisfaction with their jobs.     

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey

Patrick A., Laschinger H.K.S., Wong C. & Finegan J. (2011) Journal of Nursing Management 19 , 449–460
Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey Aim To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner’s model of transformational leadership. Background While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. Methods A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. Results Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. Conclusion The results provide encouraging evidence for the construct validity of the CLS. Implications for nursing management Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.     

The influence of leadership practices and empowerment on Canadian nurse manager outcomes

Aim To examine the influence of senior nurse leadership practices on middle and first-line nurse managers’ experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. Background Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers’ turnover intentions. Methods This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. Results The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. Conclusions Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. Implications for Nursing Management Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders.     

A partnership approach to leadership development for Directors of Nursing in Older People's services in Ireland – articulating the impact

This paper outlines the approach undertaken by the Royal College of Nursing to design, deliver and evaluate a programme of leadership development for Directors of Nursing in Older People's services commissioned by the Nursing and Midwifery Planning Development Unit Dublin, Kildare and Wicklow. The programme was developed to support Nurse Directors of these services to enhance their leadership capabilities at a time of significant health service reform and investment. The programme was underpinned by the Office of Health Management's Nursing Competency Framework ( Rush et al. 2000 ). The key influences for the programme were the significant contemporary policy and organizational developments directly experienced by Directors of Nursing. This paper will focus on the benefits for participants, commissioners and service users alike in adopting this kind of partnership approach to the design, delivery and evaluation of a bespoke RCN leadership development programme which combined the experience of RCN Gerontology alongside Leadership. Specifically, the paper focuses on the context of the commissioned work and the ways of working between the members of the delivery team and the commissioners, their roles and responsibilities and the importance of these interrelationships in the delivery of a development programme which would meet the specific needs of this key group of nurse leaders. The key learning and experiences of the Directors of Nursing are highlighted.     

The Cockcroft difference: an analysis of the impact of a nursing leadership development programme

Aim Identifying impact areas of nursing leadership development programmes is needed to determine if there are measureable effects on participants. Background These impact areas help to identify measures to substantiate the benefits of nursing leadership programmes for organization leaders making decisions about support and implementation of such opportunities for their emerging leaders. Method Using mixed qualitative/quantitative methods, the impact of a nursing leadership development programme, the Amy V. Cockcroft Fellowship, is examined to determine if there are measureable influences. Results Themes of four areas of impact: improved conflict resolution/negotiation skills, communication skills, personal development and career action or change were identified through content analysis. Conclusions These themes provide the basis for creating measureable indicators for nursing organizations to use in determining the value of nursing leadership development programmes such as the Amy V. Cockcroft Fellowship. Implications for nursing management Based on the findings established in this research article, nurse managers can focus on developing themselves and their peer groups through nursing leadership development programmes to prepare for leading in the present and future healthcare environment.     

Promoting leadership: the development of a nurse executive team in an acute hospital trust

Aim The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme. Background This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted. Method A questionnaire using quantitative and qualitative measures was used to explore the group’s leadership style and evaluate the professional development programme. Findings The findings show how the development programme worked and what clarity it afforded the group in terms of their leadership style. Group work, building on the findings, helped them define their particular characteristics, skills and leadership ability and what further work was needed to demonstrate this. Conclusions The issues raised, such as team‐working, mutual purpose and personal development, are discussed in terms of their function within an integrated executive team with vision and goals. Implications for nursing management In ensuring that the nursing service has positive purpose, direction and goals, there needs to be a strategic approach to corporate development; otherwise, nursing will struggle to lead itself within a fast changing health care system.     

Evidence-based practice: the importance of education and leadership

johansson b., fogelberg-dahm m. & wadensten b . (2010) Journal of Nursing Management 18 , 70–77
Evidence-based practice: the importance of education and leadership
Aim  To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors.
Background  Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance.
Method  All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire.
Results  The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities.
Conclusions  The present study highlights the value of education in research methods and the importance of supportive leadership.
Implications for nursing management  Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.     

The influence of nursing leadership on nurse performance: a systematic literature review

brady germain p. & cummings g.g. (2010) Journal of Nursing Management 18, 425–439
The influence of nursing leadership on nurse performance: a systematic literature review Aim The aim was to explore leadership factors that influence nurse performance and particularly, the role that nursing leadership behaviors play in nurses’ perceptions of performance motivation. Background Nurse performance is vital to quality patient care outcomes and nursing leadership behaviors have been linked to nurse performance. Evaluations A review of research articles that examined the factors that nurses perceived as influencing their motivation and performance was conducted. Eight studies were included in the final analysis. Key issues Nurses’ perceptions of factors that affect their motivation and ability to perform were grouped into five categories using content analysis: autonomy, work relationships, resource accessibility, nurse factors, and leadership practices. Nursing leadership behaviors were found to influence both nurses’ motivations directly and indirectly via other factors. Conclusion The review suggests that nurse performance may be improved by addressing nurse autonomy, relationships among nurses, their colleagues and leaders, and resource accessibility. Implications for nursing management Nursing managers and leaders may enhance their nurses’ performance by understanding and addressing the factors that affect their ability and motivation to perform.     

The state of the science of emotional intelligence related to nursing leadership: an integrative review

akerjordet k. & severinsson e. (2010) Journal of Nursing Management 18, 363–382
The state of the science of emotional intelligence related to nursing leadership: an integrative review Aim To explore the state of the science of emotional intelligence (EI) related to nursing leadership and its critiques. Background The phenomenon of EI has emerged as a potential new construct of importance for nursing leadership that enhances educational, organizational, staff and patient outcomes. Nevertheless, important questions and critical reflections related to exaggerated claims, conceptualizations and measurements exist. Method A literature search was conducted using international databases covering the period January 1999 to December 2009. A manual search of relevant journals and significant references increased the data. Results Critical reflection seems to be associated with the unsubstantiated predictive validity of EI in the area of nursing leadership. In addition, important moral issues are called into question. Conclusions It is important to possess in-depth knowledge of EI and its scientific critique when integrating the concept into nursing research, education and practical settings. More attention to the nature of emotion in EI is necessary. Implications for nursing leadership The dynamics of EI should be explored in the context of both the surrounding environment and individual differences, as the latter can be adaptive in some settings but harmful in others.